1885. Pneumococcal Pneumonia Requiring Hospitalization in US Children in the 13-Valent Pneumococcal Conjugate Vaccine Era
Session: Poster Abstract Session: Vaccines: PCV
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • LisetOlarte_PostersInThePark_IDweek2015_v5 (1).pdf (607.6 kB)
  • Background: The incidence of complicated pediatric pneumococcal pneumonia (PP) increased in the late 2000s. Few data exist on the impact of PCV13 on PP in children. We compared the serotype (ST) distribution, antibiotic susceptibility and outcomes of children with PP 4 yrs before and 4 yrs after the introduction of PCV13.

     

    Methods: We identified patients ≤18 years with PP at 8 children's hospitals in the US (2006-2014). Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Clinical and laboratory data were collected retrospectively. Patients were divided into 3 subgroups: pre-PCV13 (2006-2009), transitional year (2010) and post-PCV13 (2011-2014). Dichotomous variables were analyzed by Χtest and continuous variables with non-parametric tests.

     

    Results: During this study, 391 of 1533 (25.5%) children with invasive pneumococcal disease (IPD) had PP. PP/IPD proportion decreased 28.6% (233/826 vs 109/537, p = 0.001). The total number of PP cases decreased 46.8% from 2006-2009 to 2011-2014. [Figure].

     

     

    2006-2009

    N=233 (%)

    2011-2014

    N=109 (%)

    P

    Age, months [IQR]

    40.9 [24.1-67.1]

    48.0 [22.0-79.0]

    0.4

    Comorbidity

    58 (24.9)

    40 (36.7)

    0.02

    PCV13 STs*

    201 (90.1)

    70 (66.7)

    <0.001

    ST 19A*

    111 (49.8)

    33 (31.4)

    0.002

    ST 3*

    29 (13.0)

    20 (19.0)

    0.2

    ST 7F*

    24 (10.8)

    13 (12.4)

    0.7

    ST 1*

    23 (10.3)

    2 (1.9)

    0.006

    Penicillin MIC ≥4.0 g/ml*

    20 (9.0)

    3 (2.9)

    0.04

    Ceftriaxone MIC ≥2.0 g/ml*

    12 (5.4)

    1 (0.9)

    0.07

    Clindamycin resistance*

    60 (26.9)

    22 (20.9)

    0.2

    *Denominator is 223 for 2006-2009 and 105 for 2011-2014.

    The most common non-PCV13 STs during 2011-2014 were 33F (n=6), 35B and 22F (n=4 each). In 2014, the most common STs were 3 (n=6), 19A (n=4) and 35B (n=3). In 2011-2014, 65% of patients with PP had not received a dose of PCV13. Clinical data was available from 297 patients; among them cases of bacteremic PP (96/160 vs 47/82), empyemas (101/173 vs 44/88), necrotizing PP (59/173 vs 25/88) and hemolytic-uremic syndrome (12/173 vs 2/88) remained unchanged after PCV13 introduction. Need for intensive care, mechanical ventilation and invasive procedure remained unchanged.

     

    Conclusion: Total number of PP cases decreased 46.8% in children after PCV13 introduction. PCV13 STs 19A and 3 were responsible for half of the cases of PP in 2011-2014.

    Liset Olarte, MD1, William J. Barson, MD, FPIDS2, Ryan M Barson, MD2, Jose R. Romero, MD3, John S. Bradley, MD, FPIDS4, Tina Tan, MD, FIDSA5, Laurence B. Givner, MD6, Jill Hoffman, MD7, Philana Ling Lin, MD8, Kristina G. Hulten, PhD1, Edward Mason Jr, PhD1 and Sheldon L. Kaplan, MD, FIDSA1, (1)Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (2)Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, (3)University of Arkansas for Medical Sciences, Little Rock, AR, (4)Rady Children's Hospital - San Diego, San Diego, CA, (5)Northwestern University Feinberg School of Medicine, Chicago, IL, (6)Wake Forest University School of Medicine, Winston-Salem, NC, (7)Children's Hospital, Los Angeles, Los Angeles, CA, (8)Children's Hospital of Pittsburgh, Pittsburgh, PA

    Disclosures:

    L. Olarte, None

    W. J. Barson, None

    R. M. Barson, None

    J. R. Romero, None

    J. S. Bradley, None

    T. Tan, None

    L. B. Givner, None

    J. Hoffman, None

    P. L. Lin, None

    K. G. Hulten, None

    E. Mason Jr, None

    S. L. Kaplan, Forest Labs: Grant Investigator , Grant recipient
    Pfizer: Grant Investigator , Grant recipient

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